Kim Tae Han, Lee Eui Jung, Shin Sang Do, Ro Young Sun, Kim Yu Jin, Ahn Ki Ok, Song Kyoung Jun, Hong Ki Jeong, Lee Kyung Won
Prehosp Emerg Care. 2018 Mar-Apr;22(2):214-221. doi: 10.1080/10903127.2017.1367443. Epub 2017 Sep 27.
Korean national emergency care protocol for EMS providers recommends a minimum of 5 minutes of on-scene resuscitation before transport to hospital in cases of Out-of-Hospital Cardiac Arrest (OHCA). We compared survival outcome of OHCA patients according to scene time interval (STI)-protocol compliance of EMS.
EMS treated adult OHCAs with presumed cardiac etiology during a two-year period were analyzed. Non-compliance was defined as hospital transport with STI less than 6 minutes without return of spontaneous circulation (ROSC) on scene. Propensity score for compliance with protocol was calculated and based on the calculated propensity score, 1:1 matching was performed between compliance and non-compliance group. Univariate analysis as well as multivariable logistic model was used to evaluate the effect of compliance to survival outcome.
Among a total of 28,100 OHCAs, EMS transported 7,026 (25.0%) cardiac arrests without ROSC on the scene with an STI less than 6 minutes. A total of 6,854 cases in each group were matched using propensity score matching. Overall survival to discharge rate did not differ in both groups (4.6% for compliance group vs. 4.5 for non-compliance group, p = 0.78). Adjusted odds ratio of compliance for survival to discharge were 1.12 (95% CI 0.92-1.36). More patients with favorable neurological outcome was shown in compliance group (2.5% vs. 1.7%, p < 0.01) and adjusted odds ratio was 1.91 (95% CI 1.42-2.59).
Although survival to discharge rate did not differ for patient with EMS non-compliance with STI protocol, lesser patients survived with favorable neurological outcomes when EMS did not stay for sufficient time on scene in OHCA before transport.
韩国针对急救医疗服务（EMS）人员的国家紧急护理协议建议，对于院外心脏骤停（OHCA）患者，在转运至医院之前，现场复苏时间至少为5分钟。我们根据EMS的现场时间间隔（STI）-协议依从性，比较了OHCA患者的生存结局。
分析了EMS在两年期间治疗的成年疑似心脏病因的OHCA患者。不依从定义为STI少于6分钟且现场无自主循环恢复（ROSC）就转运至医院。计算协议依从性的倾向评分，并根据计算出的倾向评分，在依从组和不依从组之间进行1:1匹配。采用单因素分析以及多变量逻辑模型来评估依从性对生存结局的影响。
在总共28100例OHCA患者中，EMS将7026例（25.0%）现场无ROSC且STI少于6分钟的心脏骤停患者转运至医院。使用倾向评分匹配法在每组中匹配了总共6,854例病例。两组的总体出院生存率无差异（依从组为4.6%，不依从组为4.5%，p = 0.78）。出院生存的依从性调整优势比为1.12（95%可信区间0.92 - 1.36）。依从组中显示出更多神经功能良好结局的患者（2.5%对1.7%，p < 0.01），调整优势比为1.91（95%可信区间1.42 - 2.59）。
尽管EMS不遵守STI协议的患者出院生存率没有差异，但在OHCA患者转运前，如果EMS在现场停留时间不足，神经功能良好结局存活的患者会更少。
